Provider Demographics
NPI:1962601781
Name:UNIVERSAL CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:UNIVERSAL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-821-1111
Mailing Address - Street 1:PO BOX 91325
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89009-1325
Mailing Address - Country:US
Mailing Address - Phone:702-821-1111
Mailing Address - Fax:
Practice Address - Street 1:5900 W CHARLESTON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1143
Practice Address - Country:US
Practice Address - Phone:702-821-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36534Medicare UPIN
NV36533Medicare PIN